Shape lockable apparatus and method for advancing an instrument through unsupported anatomy

ABSTRACT

Apparatus and methods are provided for placing and advancing a diagnostic or therapeutic instrument in a hollow body organ of a tortuous or unsupported anatomy, comprising a handle, an overtube disposed within a hydrophilic sheath, and a distal region having an atraumatic tip. The overtube may be removable from the handle, and have a longitudinal axis disposed at an angle relative to the handle. The sheath may be disposable to permit reuse of the overtube. Fail-safe tensioning mechanisms may be provided to selectively stiffen the overtube to reduce distension of the organ caused by advancement of the diagnostic or therapeutic instrument. The fail-safe tensioning mechanisms reduce the risk of reconfiguration of the overtube in the event that the tension system fails, and, in one embodiment, rigidizes the overtube without substantial proximal movement of the distal region. The distal region permits passive steering of the overtube caused by deflection of the diagnostic or therapeutic instrument, while the atraumatic tip prevents the wall of the organ from becoming caught or pinched during manipulation of the diagnostic or therapeutic instrument.

REFERENCE TO RELATED APPLICATIONS

[0001] This application is a continuation-in-part of U.S. patentapplication Ser. Nos. 10/173,203, 10/173,227, 10/173,238 and 10/173,220,all of which were filed Jun. 13, 2002 and are incorporated herein byreference in their entireties.

FIELD OF THE INVENTION

[0002] The present invention relates to apparatus and methods forplacing and advancing a diagnostic or therapeutic instrument in a hollowbody organ of unsupported anatomy, while reducing patient discomfort andrisk of injury.

BACKGROUND OF THE INVENTION

[0003] The use of the colonoscope for examining the interior of thelarge intestine or colon is well-known. In general, a physicianperforming an examination or treatment of the colon inserts acolonoscope into the anus and then advances the colonoscope into thecolon. A complete examination requires the physician to advance thecolonoscope into the colon, negotiate the sigmoid colon, and left andright colic flexures up to the cecum. Advancement of the colonoscope isgenerally accomplished by manipulation of a steerable tip of thecolonoscope, which is controlled at the proximal end of the device bythe physician, in addition to torquing and pushing the scope forward orpulling it backward.

[0004] Problems regularly occur, however, when negotiating thecolonoscope through the bends of the colon, such as at the sigmoid andleft and right colic flexures. These problems arise because the colon issoft and has unpredictable fixation points to the viscera of theabdomen, and it is easily distensible. Consequently, after the steerabletip of the colonoscope is deflected to enter a new region of the colon,the principal direction of the force applied by the physician urging theproximal end of the device into the patient's colon is not in thedirection of the steerable tip. Instead, the force is directed along theaxis of the colonoscope towards the preceding bend(s), and causesyielding or displacement of the colon wall.

[0005] The loads imposed by the colonoscope on the colon wall can have amyriad of possible effects, ranging from patient discomfort to spasticcramp-like contractions of the colon and even possible perforation ordissection of the colon. Consequently, the colonoscope cannot beadvanced as far as the cecum in up to one-sixth of all cases.

[0006] To address some of these difficulties, it is known to employ aguide tube that permits a colonoscope to be advanced through the rectum.One such device is described in U.S. Pat. No. 5,779,624 to Chang. Analternative approach calls for inserting the colonoscope through acurved region, and then mechanically actuating the portion of the devicein the curved region to cause it to straighten, as described in U.S.Pat. No. 4,601,283 to Chikama.

[0007] Many patients find the operation of such previously-known devicesunpleasant because the sigmoid portion of the colon is forced into analmost rectilinear shape by the guide tube. Due to the stiffness of theguide tube, careless handling of the guide tube presents a risk ofinjury to the colon.

[0008] Other previously-known apparatus and methods use an overtubehaving variable rigidity, so that the overtube may be inserted throughcurved anatomy in a flexible state, and then selectively stiffened toresist bending forces generated by passing a colonoscope through theovertube. One example of such a device is described in U.S. Pat. No.5,337,733 to Bauerfiend. The device described in that patent comprisesinner and outer walls having opposing ribs spaced apart across anair-filled annulus. The ribs are selectively drawn together tointermesh, and form a rigid structure by evacuating the annulus.

[0009] Another previously-known endoscopic device for deliveringaneurysm clips within a hollow organ or vessel is described in U.S. Pat.No. 5,174,276 to Crockard. The device described in that patent includesa conduit formed from a multiplicity of elements that are capable ofangulation relative to one another, and which becomes rigid whensubjected to a tensile force. The device is described as beingparticularly useful in neurosurgery, where the variable rigidity of thedevice is useful for providing a stable platform for neurosurgicalinterventions, such as clipping an aneurysm.

[0010] While previously-known apparatus and methods provide somesuggestions for solving the difficulties encountered in advancingdiagnostic or therapeutic instruments through easily distensible bodyorgans, few devices are commercially available. Although the precisereasons for this lack of success are uncertain, previously-known devicesappear to pose several problems.

[0011] For example, the devices described in the Bauerfiend and Crockardpatents appear to pose a risk of capturing or pinching tissue betweenthe endoscope/colonoscope and the distal end of the overtube or conduitwhen the scope is translated. Also, neither device provides any degreeof steerability, and must be advanced along the pre-positioned scope. Inaddition, the bulk of the proximal tensioning system described inCrockard is expected to interfere with manipulation of the endoscope.Other drawbacks of previously-known devices may be related to thecomplexity or cost of such devices or the lack of suitable materials. Inany event, there exists an un-met need for devices to solve thislong-felt problem in the field of endoscopy and colonoscopy.

[0012] In view of the foregoing, it would be desirable to provideapparatus and methods for facilitating placement of diagnostic ortherapeutic instruments within easily distensible hollow body organs,such as the esophagus or colon.

[0013] It further would be desirable to provide apparatus and methodsthat permit a diagnostic or therapeutic device to be advanced into ahollow body organ, and which facilitates passage of the device throughtortuous anatomy without requiring straightening of organ passagewaysalready traversed.

[0014] It also would be desirable to provide apparatus and methods forfacilitating placement of diagnostic or therapeutic instruments withineasily distensible hollow body organs that include means for reducingthe risk that tissue will become inadvertently pinched between theapparatus and the advancing or withdrawing instrument, or caught as thediagnostic or therapeutic instrument is maneuvered through the hollowbody organ.

[0015] It still further would be desirable to provide apparatus andmethods that provide a low-cost, single use, easily manufacturable guidefor inserting a diagnostic or therapeutic instrument in a hollow bodyorgan.

[0016] It yet further would be desirable to provide apparatus andmethods that provide a low-cost, easily manufacturable guide forinserting a diagnostic or therapeutic instrument in a hollow body organ,wherein a portion of the apparatus is disposable after a single use anda remaining portion of the device is re-usable.

[0017] Still further, it would be desirable to provide a device having aselectively locking shape for inserting a diagnostic or therapeuticinstrument in a hollow body organ, but which facilitates manipulation ofa proximal end of the diagnostic or therapeutic instrument.

[0018] It additionally would be desirable to permit multiple diagnosticor therapeutic devices to be positioned in a hollow, unsupported organ,so that at least one of the devices may be withdrawn and repositionedwhile the other devices are retained in place.

[0019] It further would be desirable to provide apparatus and methodsfor facilitating placement of diagnostic or therapeutic instrumentswithin easily distensible hollow body organs that reduces the risk ofreconfiguration of the apparatus in the event of failure of the device.

[0020] It yet further would be desirable to provide apparatus andmethods for facilitating placement of diagnostic or therapeuticinstruments within easily distensible hollow body organs thatsubstantially maintains an axial length of the apparatus.

SUMMARY OF THE INVENTION

[0021] In view of the foregoing, it is an object of the presentinvention to provide apparatus and methods for facilitating placement ofdiagnostic or therapeutic instruments within easily distensible orunpredictably supported hollow body organs, such as the esophagus orcolon.

[0022] It is a further object of the present invention to provideapparatus and methods that permit a diagnostic or therapeutic device tobe advanced into a hollow body organ, and which facilitates passage ofthe device through tortuous anatomy without requiring straightening oforgan passageways already traversed.

[0023] It also is an object of the present invention to provideapparatus and methods for facilitating placement of diagnostic ortherapeutic instruments within easily distensible hollow body organsthat include means for reducing the risk that tissue will becomeinadvertently pinched or caught as the diagnostic or therapeuticinstrument is maneuvered through the hollow body organ.

[0024] It is a still further object of the present invention to provideapparatus and methods that provide a low-cost, single use, easilymanufacturable guide for inserting a diagnostic or therapeuticinstrument in a hollow body organ.

[0025] It is another object of this invention to provide apparatus andmethods that provide a low-cost, easily manufacturable guide forinserting a diagnostic or therapeutic instrument in a hollow body organwherein a portion of the apparatus is disposable after a single use anda remaining portion of the device is re-usable.

[0026] Still further, it is an object of the present invention toprovide a device having a selectively locking shape for inserting adiagnostic or therapeutic instrument in a hollow body organ, but whichfacilitates manipulation of a proximal end of the diagnostic ortherapeutic instrument.

[0027] It is yet another object of the present invention to permitmultiple diagnostic or therapeutic devices to be positioned in a hollow,unsupported organ, so that at least one of the devices may be withdrawnand repositioned while the other devices are retained in place.

[0028] It is a further object of the present invention to provideapparatus and methods for facilitating placement of diagnostic ortherapeutic instruments within easily distensible hollow body organsthat reduces the risk of reconfiguration of the apparatus in the eventof failure of the device.

[0029] It is a still further object of the present invention to provideapparatus and methods for facilitating placement of diagnostic ortherapeutic instruments within easily distensible hollow body organsthat substantially maintains an axial length of the apparatus.

[0030] These and other objects of the present invention are attained byproviding apparatus comprising a proximal handle, an overtube coupled tothe proximal handle and having a distal region, an atraumatic tipdisposed on the distal region, and mechanisms for selectively lockingthe shape of the overtube to assist one or more diagnostic ortherapeutic instruments to negotiate the tortuous or unsupported anatomyof a hollow body organ, rather than distending the wall of the organ.The apparatus includes a main lumen extending between the handle,overtube and atraumatic tip, through which a diagnostic or therapeuticinstrument, such as an endoscope or colonoscope, may be translated.

[0031] The handle extends from the patient, e.g., through the mouth oranus, where it can be manipulated by the physician. The proximal handlemay form part of a single use, disposable apparatus, or may be separablefrom the overtube and reusable. Alternatively, the overtube may includea disposable single-use cover that fits over a reusable structure. Theovertube may be angled relative to a working axis of the handle, so thatthe handle does not interfere with manipulation of the diagnostic ortherapeutic instrument inserted through the overtube.

[0032] An overtube constructed in accordance with the principles of thepresent invention may comprise a multiplicity of nested elements thatare selectively-tensionable by actuation of a ratchet, a pneumaticmechanism, or shape memory materials. Alternatively, the overtube mayinclude a series of interconnected links surrounded by a selectivelyactuable clamping mechanism, a tubular member comprising a multiplicityof helical links formed from a material having variable durometer andsurrounded by a clamping mechanism, a thermo-responsive polymer oralloy, an elongate, flexible tube made from an electroactive polymer, ora series of overlapping or nested links that are made from a shapememory material. The overtube may include any of a number of aids forfacilitating passage of the diagnostic or therapeutic instrument throughthe main lumen, including a lubricious liner, rails or rollers.

[0033] The tensioning systems may provide a fail-safe mode that reducesthe risk of reconfiguration of the overtube in the event that themechanism fails. The fail-safe mode may equalize compressive clampingloads applied to the overtube when the overtube is rigidized, and beconfigured to rigidize the overtube without substantial proximalmovement of the distal region.

[0034] The liner may be made from thin, flexible material, have ahydrophilic coating, incorporate a kink-resistant coil, or combinationsthereof. Alternatively, the liner may be a disposable sheath that may beremoved from the overtube to permit re-use of the internal structure ofthe overtube.

[0035] The atraumatic tip of the present invention preferably isconfigured to reduce the risk of capturing or pinching tissue betweenthe overtube and a diagnostic or therapeutic instrument that isselectively translated through the overtube. This is preferablyaccomplished by the atraumatic tip applying a radially-outwardlydirected load to the wall of the hollow body organ in the vicinity ofthe distal region where the diagnostic or therapeutic instrument exitsthe apparatus.

[0036] In addition, the distal region of the overtube preferablyincludes a flexible portion that permits a steerable tip of a diagnosticor therapeutic device disposed within the distal region to deflect thedistal region of the overtube in a desired direction. This permits theovertube to be readily advanced together with the steerable tip of thediagnostic or therapeutic device.

BRIEF DESCRIPTION OF THE DRAWINGS

[0037] Further features of the invention, its nature and variousadvantages will be more apparent from the accompanying drawings and thefollowing detailed description of the preferred embodiments, in which:

[0038]FIG. 1 is a schematic view of a human colon illustrating a commondifficulty encountered in advancing a colonoscope beyond the sigmoidcolon;

[0039]FIG. 2 is a side view of illustrative apparatus of the presentinvention;

[0040]FIG. 3A is a side-sectional exploded view of nestable elements ofa first embodiment of an overtube suitable for use in the apparatus ofFIG. 2;

[0041]FIG. 3B is a side view of two of the nestable elements of FIG. 3Anested together;

[0042]FIG. 4 is a side-sectional view of a distal region of theapparatus of FIG. 2 constructed in accordance with principles of thepresent invention;

[0043]FIG. 5 is a side-sectional view of an illustrative arrangement ofa mechanism suitable for use in the handle of the apparatus of FIG. 2;

[0044]FIG. 6 is a side-sectional view of the detail of a wire clampingsystem suitable for use in the handle of FIG. 5;

[0045] FIGS. 7A-7C are schematic views of a method of using theapparatus of the present invention;

[0046]FIG. 8 is a schematic view of an alternative step in the method ofusing the apparatus of the present invention;

[0047]FIG. 9 is a side view of an alternative embodiment of theapparatus of the present invention;

[0048] FIGS. 10A-10C are schematic views of components of a tensioningmechanism suitable for rigidizing the overtube of the present invention,wherein the components provide a fail-safe mode;

[0049]FIG. 11 is a cut-away side view of a tensioning mechanismincorporating the components of FIGS. 10A and 10B within the handle ofthe apparatus of FIG. 2;

[0050] FIGS. 12A-12D are schematic perspective views of alternativecomponents of a tensioning mechanism that each provide a fail-safe mode;

[0051]FIGS. 13A and 13B are, respectively, a side sectional view of atensioning mechanism incorporating the pulley manifold of FIG. 12Bwithin the handle of the apparatus of FIG. 2, and an indicator thatdisplays the status of the overtube;

[0052] FIGS. 14A-14C are cut-away side views of an alternativetensioning mechanism that transitions the overtube of the presentinvention between flexible and rigid states with successive actuations;

[0053]FIG. 15 is a side sectional view of yet another alternativetensioning mechanism employing pneumatic actuation;

[0054]FIG. 16 is a side sectional view of a further alternativetensioning system that transitions the overtube of the present inventionfrom a flexible state to a rigid state without substantial movement of adistal end of the overtube;

[0055]FIGS. 17A and 17B, respectively, are a side-section view of analternative element suitable for use in the overtube of FIG. 2 and aroller element suitable for use with the element of FIG. 17A,respectively;

[0056]FIGS. 18A and 18B depict the use of lubricious rails in theovertube of the apparatus of FIG. 2 or 9 to facilitate passage of adiagnostic or therapeutic device through the main lumen;

[0057]FIG. 19 is a side-sectional view of an alternative nestableelement having an integral lubricious lining;

[0058]FIGS. 20A and 20B are side-sectional views of alternative nestableelements that form a smooth internal lumen when nested together;

[0059] FIGS. 21A-21D are still further alternative embodiments of thenestable elements of FIG. 3, in which the nestable elements aremacroscopically textured to enhance friction;

[0060]FIG. 22 is a schematic view of the lumen of the overtube of thepresent invention depicting the use of multiple devices;

[0061] FIGS. 23-28 depict side-sectional views of various alternativeembodiments of an atraumatic tip constructed in accordance with thepresent invention;

[0062]FIGS. 29 and 30 are alternative embodiments of the overtube of thepresent invention, having tensioning systems that employ shape memorymaterials;

[0063] FIGS. 31A-31C are, respectively, a side-sectional view of analternative embodiment of an overtube suitable for use in the presentinvention having a multiplicity of interconnected links surrounded by aclamping sleeve, and cross-sectional views of portions of the sleeve;

[0064]FIG. 32 is a side-sectional view of a further alternativeembodiment of an overtube constructed in accordance with the presentinvention having a spiral bladder to actuate the clamping links;

[0065]FIG. 33 is a side-sectional view of another alternative embodimentof an overtube of the present invention having thermally-actuable bands;

[0066]FIGS. 34A and 34B are side-sectional views of a yet furtheralternative embodiment of an overtube of the present inventioncomprising a series of helical links having regions of differentdurometer;

[0067]FIG. 35 is a side-sectional view of a still further alternativeembodiment of an overtube suitable for use with the present inventioncomprising a series of links having proximal and distal rims thatinterlock;

[0068]FIG. 36 is a side-sectional view of another alternative embodimentof the present invention comprising a series of links that form coactingjoints;

[0069]FIG. 37 is a side-sectional view of yet another alternativeembodiment of an overtube having thermally regulated stiffness;

[0070] FIGS. 38A-38C are schematic views of yet another alternativeembodiment of an overtube suitable for use with the present invention,in which the diameters of tension wire lumens extending through theovertube vary responsive to electrical energization;

[0071]FIG. 39 is a side-sectional view of still another alternativeembodiment of an overtube having a series of electrically activatedlinks disposed in an overlapping fashion around a series of rigid links;

[0072]FIGS. 40A and 40B are side-sectional views of, respectively, anelectrically activated nestable link and a plurality of the electricallyactivated nestable link of FIG. 40A nested together to form an overtubesuitable for use with the apparatus of the present invention;

[0073]FIG. 41 is a side-sectional view of a disposable sheath for usewith the overtube of the present invention; and

[0074]FIG. 42 is a schematic side view of a strap that couples theapparatus of the present invention to a colonoscope.

DETAILED DESCRIPTION OF THE INVENTION

[0075] Referring to FIG. 1, problems associated with previously-knownapparatus and methods for inserting and advancing a diagnostic ortherapeutic instrument into a hollow body organ having tortuous orunsupported anatomy, illustratively, patient's colon C, are described.Colon C includes sphincter muscle SM disposed between anus A and rectumR. Rectum R is coupled via the rectosigmoid junction RJ to sigmoid colonSC. Sigmoid colon SC joins descending colon DC, which in turn is coupledto transverse colon TC via left colic flexure LCF. Transverse colon TCalso is coupled by right colic flexure RCF to ascending colon AC andcecum CE, which receives waste products from the small intestine.

[0076] As illustrated in FIG. 1, colonoscope 10 having steerable distaltip 11 is typically inserted through anus A into rectum R, and thensteered through rectosigmoid junction RJ into sigmoid colon SC. Asdepicted in FIG. 1, distal tip 11 of colonoscope 10 is advanced throughsigmoid colon SC and deflected into descending colon DC. Further urgingof the colonoscope by the physician can cause region 12 of thecolonoscope to bear against and cause displacement of the rectosigmoidjunction RJ, as illustrated by dotted lines 12′ and RJ′ in FIG. 1.

[0077] Such distension may result in patient discomfort or spasm, and ifunnoticed, could result in injury to the colon. The potential formovement of colonoscope to cause distension, discomfort or spasm is alsogreat where the colonoscope must negotiate left colic flexure LCF andright colic flexure RCF, and results in a large portion of suchexaminations terminating before the physician can advance distal tip 11to cecum CE.

[0078] The present invention provides apparatus and methods for placinga diagnostic or therapeutic instrument through the tortuous orunpredictably supported anatomy of a hollow body organ, such as theesophagus or colon, while reducing the risk of distending or injuringthe organ. Apparatus constructed in accordance with the presentinvention permits an endoscope or colonoscope to be readily advancedinto a patient's tortuous or unsupported anatomy by selectivelyshape-fixing an overtube portion of the apparatus, while also preventingtissue from being captured or pinched between the overtube and scope.

[0079] Referring now to FIG. 2, apparatus 20 of the present invention isdescribed. Apparatus 20 comprises handle 21, overtube 22, and distalregion 23 having atraumatic tip 24. Handle 21 includes lumen 25 thatextends from Toughy-Borst valve 26 through overtube 22, distal region 23and atraumatic tip 24. Lumen 25 is configured to facilitate passage of astandard commercially available colonoscope, such as colonoscope 10,therethrough. Toughy-Borst valve 26 may be actuated to releasably lockcolonoscope 10 to apparatus 20 when colonoscope 10 is inserted withinlumen 25. As described hereinafter, overtube 22 is configured so that itcan be selectively transitioned between a flexible state and a rigid,shape-fixed state by actuator 27 disposed on handle 21.

[0080] In FIG. 3A, illustrative embodiment of overtube 22 comprises amultiplicity of nestable elements 30. For purposes of illustration,nestable elements 30 are shown spaced-apart, but it should be understoodthat elements 30 are disposed so that distal surface 31 of one element30 coacts with proximal surface 32 of an adjacent element. Each ofnestable elements 30 has central bore 33 to accommodate colonoscope 10,and preferably two or more tension wire bores 35. When assembled asshown in FIG. 2, nestable elements 30 are fastened with distal andproximal surfaces 31 and 32 disposed in a coacting fashion by aplurality of tension wires 36 that extend through tension wire lumens 28defined by tension wire bores 35. Tension wires 36 preferably are madefrom a superelastic material, e.g., nickel titanium alloy, to provideflexibility, kink-resistance and smooth movement of the tension wiresthrough tension wire bores 35. Alternatively, the tension wires may bemade from braided stainless steel, a single stainless steel wire,Kevlar, a high tensile strength monofilament thread, or combinationsthereof. These materials are provided only for the sake of illustrationand should in no way be construed as limiting.

[0081] In a preferred embodiment, a ratio of the diameter of tensionwires 36 to the diameter of tension wire bores 35 approximately is in arange of ½ to ⅔. Applicants have observed that this provides smoothrelative movement between the tension wires and the nestable elements,even when overtube 22 is retroflexed. While a greater ratio isdesirable, such a configuration appears to cause the edges of tensionwire bores 35 to gouge into tension wires 36, thereby constrainingmovement of the tension wires through the tension wire bores.Conversely, while applicants contemplate that a smaller ratio wouldprovide even smoother relative movement, the resultant increase in thethickness of wall 34 of each nestable element 30 is undesirable.

[0082] In a preferred embodiment, adjacent surfaces 31 and 32 of eachnestable element 30 are contoured to mate with the next adjacentelement, so that when tension wires 33 are relaxed, surfaces 31 and 32can rotate relative to one another. Tension wires 36 are fixedlyconnected to the distal end of overtube 22 at the distal ends and to atensioning mechanism disposed within handle 21 at the proximal ends.When actuated by actuator 27, tension wires 36 impose a load that clampsdistal and proximal surfaces 31 and 32 of nestable elements 30 togetherat the current relative orientation, thereby fixing the shape ofovertube 22.

[0083] When the load in tension wires 36 is released, tension wires 36provides for relative angular movement between nestable elements 30.This in turn renders overtube 22 sufficiently flexible to negotiate atortuous path through the colon. When the tensioning mechanism isactuated, however, tension wires 36 are retracted proximally to apply aclamping load to the nestable elements. This load prevents furtherrelative movement between adjacent elements 30, and stiffens overtube 22so that any distally directed force applied to colonoscope 10 causesdistal tip 11 to advance further into the colon, rather than causeovertube 22 to bear against the wall of the colon. The shape-fixedovertube absorbs and distributes vector forces, shielding the colonwall.

[0084] In a preferred embodiment, the radius of curvature of proximalsurface 32 closely approximates the radius of curvature of distalsurface 31. In particular, a ratio of the radius of curvature of distalsurface 31 to that of proximal surface 32 is in an approximate range ofabout 0.9 to 1.0. Furthermore, the coefficient of static frictionbetween the distal and proximal surfaces preferably is in an approximaterange of 0.2 to 1.4 (based on ASTM standard D1894). This structureappears to permit sufficient frictional force to develop between thesurfaces to prevent relative movement between adjacent elements whenovertube 22 is rigidized.

[0085] Nestable elements 30 may be configured to provide a stack-up ofovertube 22 that is a function of the growth height. As defined in FIG.3B, growth height H is the increase in the longitudinal length ofovertube 22 when one nestable element 30 is nested within anothernestable element 30. To accommodate the radius of curvature obtainableby standard commercially available colonoscopes, growth height Hpreferably is less than or equal to about 0.31 in, and more preferablyabout 0.16 in. This provides overtube 22 with sufficient flexibility toassume a radius of curvature that is less than or equal to approximately0.95 in. If overtube 22 needs to accommodate other endoscopes or medicalinstruments that are larger or smaller in size and/or that may assumedifferent radii of curvature, or the overtube needs to accommodatetighter anatomical constraints, applicants contemplate that growthheight H may be increased or decreased proportionate to the change indimensions of overtube 22. Applicants note that the precedinggeometrical characterization of nestable element 30 does not account formaterial interference or effects to the tension wire bores, which areomitted from FIG. 3B for illustrative purposes.

[0086] Nestable elements 30 preferably are molded from a polymer filledwith fibers of glass, carbon, or combinations thereof. In a particularlyuseful embodiment, nestable elements 30 are molded from polyurethanefilled with 20-40% by volume of glass fibers, 20-40% by volume of carbonfibers, or 20-40% by volume of glass and carbon fibers. One example isisoplast 2540, which is available from Dow Chemicals, Midland, Mich.Applicants have observed that such materials enhance friction betweenadjacent elements, which advantageously reduces the risk of relativeangular movement between the adjacent elements when overtube 22 isstiffened and, thus, reduces the risk of undesired reconfiguration ofovertube 22 in its shape-locked state. While a greater amount of glassand/or carbon fibers is desirable, such a material appears to reduce thestructural integrity of the nestable element.

[0087] Furthermore, fiber embedded polymers increase the rigidity ofnestable elements 30 so that longitudinal contraction of overtube 22 issignificantly reduced when the overtube is stiffened. Longitudinalcontraction develops when tension wires 36 are actuated to apply acompressive clamping load to overtube 22. The resultant pressureeliminates any gaps between adjacent elements 30 and deflects theproximal portion of each nestable element radially outward. Thisforeshortens each element in the longitudinal direction, so thatovertube 22 contracts in the axial length.

[0088] Typically, an overtube made from polymeric nestable elementswithout inclusion of glass and/or carbon fibers will contractapproximately 8-12% in the longitudinal direction when a compressiveforce of approximately 30 lbs is applied. By comparison, when acompressive load of 30 lbs is applied to nestable elements made from aglass and/or carbon fiber embedded polymer, as in the preferredembodiment of the present invention, the overtube only contractsapproximately 4%. Advantageously, this reduces trauma to the patient byproviding greater accuracy during use of the present invention, which isparticularly important in delicate procedures. In addition to glassand/or carbon filled polymers, it will be apparent to one of ordinaryskill in the art that nestable elements 30 also may be molded ormachined from other polymers and/or metals, such as polyurethane,polyvinyl chloride, polycarbonate, nylon, titanium, tungsten, stainlesssteel, aluminum, or combinations thereof. Indeed, nestable elements 30made from metals experience a longitudinal contraction even less thanthat experienced by fiber embedded polymers. These materials areprovided only for the sake of illustration, and one of ordinary skill inthe art will recognize numerous additional materials that are suitablefor use with the apparatus of the present invention.

[0089] Referring now to FIG. 4, an illustrative embodiment of distalregion 23 and atraumatic tip 24 is described. Distal region 23 comprisesflexible, kink-resistant coil 41 encapsulated in flexible layer 42.Layer 42 preferably comprises a soft elastomeric and hydrophilic coatedmaterial, such as silicon or synthetic rubber, and terminates at thedistal end in enlarged section 44 that forms atraumatic tip 24. At theproximal end, layer 42 joins with or is integrally formed with liner 43that extends through bores 33 of nestable elements 30 to handle 21. In apreferred embodiment, liner 43 is made of a thin, flexible materialoptionally having flexible, kink-resistant coil 29 embedded therein. Thematerial of liner 43 preferably has a high durometer within the range of30-80D, but also may have a lower or higher durometer.

[0090] Layer 42 preferably joins with or is integrally formed withflexible elastomeric skin 45 to form sheath 48, which encapsulatesnestable elements 30 in annular chamber 46. Skin 45 provides arelatively smooth outer surface for overtube 22, and prevents tissuefrom being captured or pinched during relative rotation of adjacentnestable elements 30. In a preferred embodiment, aggregate thickness Tof skin 45, nestable elements 30 and liner 43, is less than or equal toapproximately 2.5 mm, and more preferably less than or equal to 1 mm.For example, skin 45 may have a thickness of 0.13 mm, or more preferably0.1 mm, element 30 may have a thickness of 1.9 mm, and more preferably0.7 mm, and liner 43 may have a thickness of 0.38 in, or more preferably0.15 mm.

[0091] In accordance with one aspect of the present invention,colonoscope 10 may be positioned with its distal tip 11 disposed indistal region 23, so that deflection of steerable distal tip 11 impartsan angular deflection to distal region 23 and atraumatic tip 24. Toensure that there is no gross relative motion between colonoscope 10 andapparatus 20, Toughy-Borst valve 26 is tightened to engage apparatus 20to the colonoscope. In this manner, colonoscope 10 and distal region 23may be simultaneously advanced through the colon, with the distal tip ofthe colonoscope providing a steering capability to apparatus 20.Apparatus 20 therefore may be advantageously advanced together withcolonoscope 10 when overtube 22 is in the flexible state, reducingrelative motion between apparatus 20 and colonoscope 10 to thoseinstances where overtube 22 must be shape-locked to prevent distensionof the colon.

[0092] Still referring to FIG. 4, terminations 47 of tension wires aredescribed. Terminations 47 illustratively comprise balls welded ormolded onto the ends of tension wires 36 that ensure the tension wirescannot be pulled through tension wire bores 35 of the distal-mostnestable element 30. This ensures that the nestable elements cannot comeloose when overtube 22 is disposed within a patient.

[0093] Alternatively, terminations 47 may comprise knots formed in theends of tension wires 36, or any suitable fastener that prevents thetension wires from being drawn through the tension wire bores of thedistal-most nestable element. Advantageously, skin 45 providesadditional assurance that all of nestable elements 30 can be safelyretrieved from a patient's colon in the unlikely event of a tension wirefailure.

[0094] Referring now to FIGS. 2 and 5, tension wires 36 within overtube22, liner 43 and lumen 25 extend from distal region 23, through overtube22, and to handle 21. Within handle 21, each tension wire 36 passesthrough wire lock release 51 fixedly attached to handle 21, and wirelock 52 disposed on slide block 53. Each tension wire 36 terminates atwire tension spring 54, which maintains tension wires 36 in lighttension even when overtube 22 is in the flexible state. The degree oftension provided by wire tension springs 54 is not sufficient to clampadjacent nestable elements 30 together, but on the other hand does notlet gaps form between adjacent nestable elements, and helps to managethe tension wire take up or slack as overtube 22 makes various bends.

[0095] Slide block 53 is keyed to slide along rail 55 disposed betweenlimit blocks 56 and 57, and comprises a rigid block having a borethrough which rail 55 extends and an additional number of bores asrequired for the number of tension wires 36 employed. Rack gear 58 isfixedly coupled to slide block 53. Rack 58 mates with pinion gear 59,which is in turn driven by bi-directional pawl 60 coupled to actuator27. Pinion gear 59 may be selectively engaged by either prong 61 or 62of bi-directional pawl 60, depending upon the position of selectorswitch 63.

[0096] If prong 61 is selected to be engaged with pinion gear 59, asqueezing action applied to actuator 27, illustratively hand grip 64,causes rack 53 to move in the D direction in FIG. 5, thereby applyingtension to tension wires 36. Repeated actuation of hand grip 64 causesslide block 53 to move progressively further in direction D, therebyapplying an increasing clamping load on nestable elements 30. Any slacklengths of tension wires 36 extending below slide block 53 are taken upby wire tension springs 54. As discussed in greater detail below withrespect to FIG. 6, wire locks 52, which are affixed to slide block 53,engage and retract tension wires 36 concurrently with movement of slideblock 53 in the D direction.

[0097] If prong 62 is instead chosen by selector switch 63 to engagepinion gear 59, repeated actuation of hand grip 64 causes slide block 53to translate in direction U, thereby relaxing the tensile load appliedby tension wires 36 to nestable elements 30. Repeated actuation of handgrip 64 causes slide block 53 to advance in direction U until wire lockreleases 51 engage wire locks 52, releasing all tension from tensionwires 36 except that provided by wire tension springs 54. This actionpermits the clamping forces imposed on nestable elements 30 to beprogressively reduced and render overtube 22 progressively moveflexible, until when wire lock releases 51 engage wire locks 52, theovertube is returned to its most flexible state.

[0098] Referring to FIG. 6, wire lock 52 and lock release 51 aredescribed in greater detail. Wire lock 52 includes jaws 65 disposedwithin collet 66. Collet 66 includes a tapered conical bore 67. Jaws 65have ramped exterior surfaces 68 and teeth 69, and are biased againstthe surface formed by the tapered conical bore by springs 70. Teeth 69are configured to engage tension wire 36 under the bias force of springs70. When slide block 53 is moved in direction D (see FIG. 5), jaws 65engage and grasp tension wire 36 and retract the tension wire indirection D.

[0099] To disengage teeth 69 from tension wire 36, e.g., when it isdesired to allow overtube 22 to return to a flexible state, slide block53 is actuated as described previously to move in direction U. Furtheractuation of slide block 53 towards limit block 56 and wire lock release51 causes wire lock release 51 to extend into tapered conical bore 67and push jaws 65 backward against the bias of springs 70. Once tensionwires 36 are freed from jaws 65, overtube 22 returns to its mostflexible state.

[0100] Referring to FIGS. 7A-7C, a method of using apparatus 20 isdescribed. Colonoscope 10 and overtube 22 may be inserted into thepatient either simultaneously or by first backloading the overtube ontothe colonoscope. To perform simultaneous insertion, colonoscope 10 isintroduced into lumen 25 of handle 21 until distal tip 11 of thecolonoscope is disposed in distal region 23. Toughy-Borst valve 26 isactuated to lock apparatus 20 to colonoscope 10. As one unit,colonoscope 10 and overtube 22 are inserted into rectum R of thepatient, and navigated about rectosigmoid junction RJ. As discussedpreviously, steerable distal tip 11 may be used to impart angulardeflection to flexible tip 24 to steer tip 24 about tortuous curves,such as rectosigmoid junction RJ. Once distal tip 11 and tip 24 havebeen negotiated past rectosigmoid junction RJ, the current shape ofovertube 22 is locked in the manner discussed above to provide a rigidchannel through which colonoscope 10 may be further advanced into thecolon without distending rectosigmoid junction RJ. Once distal tip 11 ofcolonoscope 10 is negotiated past sigmoid colon SC, overtube 22 isreleased from its rigid state and advanced along colonoscope 10 until ittoo traverses sigmoid colon SC. Again, the current shape of overtube 22is locked to provide a rigid channel for advancement of colonoscope 10.To negotiate the remainder of the colon, such as left colic flexure LCFand right colic flexure RCF, the preceding steps may be repeated. Inthis manner, colonoscope 10 and overtube 22 may be navigated through thetortuous curves of the colon without distending the colon, and therebycausing discomfort, spasm or injury.

[0101] Alternatively, rather than simultaneously inserting bothcolonoscope 10 and overtube 22 into the patient, apparatus 20 first maybe backloaded onto the colonoscope. First, overtube 22 is threaded ontocolonoscope 10 and positioned proximal distal tip 11, as shown in FIG.8. Colonoscope 10 then is inserted into rectum R of the patient andadvanced around rectosigmoid junction RJ. Overtube 22 is advanced alongcolonoscope 10 into rectum R of the patient, using colonoscope 10 as aguide rail to negotiate rectosigmoid junction RJ. Once overtube 22traverses rectosigmoid junction RJ to the position shown in FIG. 7A, theshape of overtube 22 is locked to provide a rigid channel through whichcolonoscope 10 may be further advanced into the colon. To negotiate theremainder of the colon, the steps discussed in reference to FIGS. 7B-7Cmay be performed.

[0102] With respect to FIG. 9, an alternative embodiment of handle 21 isdescribed. Like handle 21 of FIG. 5, handle 71 also embodies aratchet-type tension mechanism, but in this embodiment overtube 22 maybe separated from handle 71, thereby permitting handle 71 to besterilized for repeated use. Handle 71 comprises housing 72 havingactuator 73 that engages teeth 74 disposed along the length of rod 75,which defines working axis W of handle 71. Push knob 76 is affixed tothe proximal end of rod 75 so that when pawl 77 is released, rod 75 maybe pushed in a distal direction. Pawl 77 engages teeth 74 of rod 75 toprevent distally-directed motion of rod 75. Spring 78 biases pawl 77against teeth 74 of rod 75, to provide a one-way ratchet effect whenactuator 73 is squeezed.

[0103] As in the embodiment of FIG. 5, tension wires 36 extend throughwire lock releases 79, wire locks 80, and are coupled to wire tensionsprings 81. Wire locks 80 are affixed to block 82, which translateswithin housing 72 responsive to movement of rod 75. Wire locks 80 andwire lock releases 79 operate in the same manner as described withreference to FIG. 6.

[0104] In operation, squeezing actuator 73, illustratively a hand grip,causes fork 83 to move rod 75 in a proximal direction so that pawl 77captures the next distal-most tooth 74. This movement also causes wirelocks 80 to engage and grasp tension wires 36 and retract the tensionwires proximally. Further actuation of actuator 73 causes overtube 22 tostiffen in the manner previously described. Spring 78 retains pawl 77 incontinuous engagement with teeth 74, thereby preventing rod 75 frommoving in the distal direction.

[0105] When it is desired to make overtube 22 more flexible, pawl 77 isreleased and knob 76 pushed in the distal direction so that wire locks80 engage wire lock releases 79. As described above, this releasestension wires 36 from wire locks 80 and permits overtube to assume itsmost flexible state.

[0106] In accordance with one aspect of the present invention, overtube22 of the embodiment of FIG. 9 may be replaceably removed from yoke 84of handle 71. In addition tension wires 36 further may compriseconnectors 85 that permit the tension wires to be disconnected. Such aconfiguration permits the overtube to be removed and discarded after asingle use, while the handle may be sterilized and reused.

[0107] Yoke 84 is also configured to position overtube 22 so thatlongitudinal axis L of the overtube is angularly displaced from workingaxis W by a predetermined angle A. This arrangement prevents handle 71from interfering with advancement of colonoscope 10 into lumen 25.

[0108] In accordance with yet another aspect of the present invention,overtube 22 includes atraumatic tip 86 that comprises a soft foam-likematerial. Atraumatic tip 86 not only facilitates advancement of overtube22 in traversing tortuous anatomy, but also serves to retain the organwall a safe distance away from the opening through which the colonoscopeis reciprocated by radially expanding the organ wall in the vicinity ofthe tip, as described hereinbelow with respect to FIG. 14A. Accordingly,atraumatic tip 86 reduces the potential for tissue to be caught orpinched in lumen 25 when the colonoscope is manipulated.

[0109] Referring now to FIGS. 10-16, alternative tensioning mechanismsare described, in which the tensioning mechanisms may provide afail-safe mode that reduces the risk of undesired reconfiguration of theovertube in the event of tensioning mechanism failure. When overtube 22is in the rigid state, the following tensioning mechanisms areconfigured to self-equalize compressive loads applied to themultiplicity of nestable elements, so that if, e.g., a tension wirebreaks, the overtube either softens into the flexible state or retainsits shape-locked state.

[0110]FIG. 10A schematically depicts components of a first embodiment ofan alternative tensioning mechanism having plurality of distal pulleys87 operably coupled via proximal tension wire 88. Proximal tension wire88 is slidably disposed within proximal pulley 89. Each tension wire 90couples adjacent tension wire lumens 28, through respective distalpulleys 87. For example, if four tension wire lumens 28 a-28 d areprovided, as in FIG. 10A, first tension wire 90 a extends from tensionwire lumen 28 a to adjacent tension wire lumen 28 b through first distalpulley 87 a. Likewise, second tension wire 90 b extends from tensionwire lumen 28 c to adjacent tension wire lumen 28 d through seconddistal pulley 87 b.

[0111] This configuration equalizes tension within tension wires 90, sothat a proximally directed force F applied to proximal pulley 89 isdistributed evenly through tension wires 90. When one of the tensionwires breaks, this configuration allows overtube 22 to soften into itsflexible state since the loss of tension in any of the tension wires istransmitted through the pulley system to the remaining tension wires.

[0112] It will be apparent to one of ordinary skill in the art thattension wires 90 a and 90 b may comprise either two separate lengths ofwire, or a single length of wire that is looped backwards aftertraversing the distal-most nestable element 30. Furthermore, while FIG.10A depicts tension wires 90 extending through adjacent tension wirelumens 28, the tension wires instead may extend through wire lumensdisposed diametrically opposite each other, as shown in FIG. 10B.Tension wires 90 preferably are made from a superelastic material, e.g.,nickel titanium alloy, but also may be made from braided stainlesssteel, single stainless steel wires, Kevlar, a high tensile strengthmonofilament thread, or combinations thereof. These materials areprovided only for the sake of illustration and should in no way beconstrued as limiting.

[0113] In an alternative embodiment illustrated in FIG. 10C, proximalpulley 89 is eliminated, and distal pulleys 87 are fixed to each other,e.g., by welding, so that a unitary pulley manifold is formed. Aproximally directed force F that is applied to the pulley manifold isdistributed evenly through tension wires 90 that extend throughrespective distal pulleys 87 to diametrically disposed tension wirelumens 28 within overtube 22. If tension wires 90 comprise two separatelengths of wires, the risk of reconfiguration of overtube 22 is reducedif one of the wires breaks since the tension within the overtube, asdefined by the unbroken tension wire, is symmetrically balanced. If theremaining tension wire breaks, the tension wire relaxes into theflexible state. If tension wires 90 comprise a single length of wirethat breaks, the overtube immediately relaxes into the flexible state,thereby also reducing the risk of undesired configuration of theovertube in the event of tensioning system failure.

[0114] Furthermore, applicants have observed that the apparatus of thepresent invention also may comprise only one distal pulley 87 coupled toovertube 22 via a single tension wire 90 disposed through diametricallyopposite tension wire lumens 28. When a proximally directed force isapplied to the single distal pulley, the force is distributed throughthe single tension wire to impose a symmetrical compressive clampingload on overtube 22 that is sufficient to shape-lock the overtube. Whentension wire 90 breaks, overtube 22 immediately softens into itsflexible state, thereby reducing the risk of undesired reconfigurationof the overtube in the event of tensioning system failure.

[0115] Referring now to FIG. 11, lumen 25 and tension wires 90 withinovertube 22 extend from the distal region of the apparatus, throughovertube 22, and to handle 91. Within handle 91, the tension wires areslidably coupled to distal pulleys 87, which in turn are slidablycoupled to proximal pulley 89. Proximal pulley 89 is coupled to andtranslates with slide block 92, that is keyed to travel along track 93disposed within housing 94. Plunger 95 is mounted pivotally to slideblock 92 at the proximal end and slidably disposed within plungerhousing at a distal end.

[0116] Plunger housing 96 is mounted pivotally to actuator 27,illustratively hand grip 97. To bias hand grip 97 against actuationabsent an externally applied force, compression spring 98 is providedconcentrically disposed about plunger 95. Compression spring 98maintains tension wires 90 in constant tension when the tensioningmechanism is actuated to impose a clamping load. Advantageously, ifadjacent nestable elements shift slightly when overtube 22 isshape-locked, the proximal bias of compression spring 98 immediatelyadvances slide block 92 in the proximal direction to maintain arelatively constant tension load within tension wires 90, therebyreducing the risk of reconfiguration of the overtube back to theflexible state that otherwise may occur absent compression spring 98.

[0117] Hand grip 27 also includes pawl 99, which is disposed to engageteeth 100 on ratchet bar 101 to prevent distally-directed motion ofslide block 92. Ratchet bar 101 is pivotally mounted in housing 94 witha spring (not shown) that, with the aid of compression spring 98, biasespawl 99 against teeth 100 of ratchet bar 101, to provide a one-wayratchet effect when hand grip 97 is squeezed.

[0118] In operation, squeezing hand grip 97 causes pawl 99 to capturethe next proximal-most tooth 100. This movement also provides acompressive force to compression spring 98 that is transmitted to slideblock 92. The proximally-directed component of the compressive forcecauses slide block 92 to translate along track 93, proximally retractingtension wires 90 so that a clamping load is imposed on the nestableelements within overtube 22. Further actuation of hand grip 97 causesovertube 22 to stiffen progressively in the manner previously described.

[0119] Advantageously, proximal-most tooth 10 a is disposed on ratchetbar 101 at a predetermined proximal location that permits a singleactuation of hand grip 97 to completely transition overtube 22 from itsflexible state to its shape-fixed state. Furthermore, as pawl 99advances hand grip 97 closer to housing 94, the mechanical advantage ofthe actuation of the hand grip increases. More specifically, as handgrip 97 becomes increasingly horizontal, the proximally-directedcomponent of the force transmitted by compression spring 98 increases inmagnitude. Accordingly, more force is transmitted to increase tensionwithin tension wires 90, and thus increase the clamping load applied torigidize overtube 22.

[0120] When it is desired to transition overtube 22 into the flexiblestate, pawl 99 is released from engagement with teeth 100 by rotatingratchet bar 101 in the proximal direction. The release of thecompressive load applied to compression spring 98 causes hand grip 97 torotate in the distal direction and slide block 92 to retract in thedistal direction. This sufficiently relaxes tension wires 90 so that thetension wires retain little to no tension, thereby permitting overtube22 to assume its most flexible state.

[0121] Referring now to FIGS. 12A-12D, alternative embodiments offail-safe tensioning mechanisms are described, in which the plurality ofpulleys of the previous embodiment is replaced by a single pulleymanifold. In FIG. 12A, a first embodiment of a pulley manifold isdescribed. Pulley manifold 110 includes body 111 having central bore 112that accommodates colonoscope 10, first and second grooves 113 a and 113b that each accept a tension wire, and are milled or molded into lateralsurface 114 of body 111, and yoke 115 that is configured to couplepulley manifold 110 to an actuator (not shown).

[0122] First groove 113 includes a curved track that terminates at firstdistal ends 116 a disposed diametrically opposite each other at distalsurface 117. Second groove 113 b also comprises a curved track thatcrosses first groove 113 a at intersection 118, and terminates at seconddistal ends 116 b. Second distal ends 116 b are disposed at distalsurface 117 diametrically opposite each other and preferably 450 fromfirst distal ends 116 a. Similar to distal pulleys 87 of FIG. 10B, eachgroove accepts a tension wire that extends through diametricallydisposed tension wire lumens within overtube 22. To reduce frictionbetween tension wires 90 a and 90 b at intersection 118, first groove113 a may have a greater depth than that of second groove 113 b, or viceversa. To prevent tension wires 90 from disengaging from grooves 113, asleeve (not shown) may be disposed around pulley manifold 110.

[0123] If tension wires 90 comprise two separate lengths of wires, therisk of reconfiguration of overtube 22 is reduced if one of the wiresbreaks since the tension within the overtube, as defined by the unbrokentension wire, is symmetrically balanced. If the remaining tension wirebreaks, the overtube relaxes into the flexible state. If tension wires90 comprise a single length of wire, the overtube immediately relaxesinto the flexible state if the single wire breaks. Accordingly, pulleymanifold 110 provides overtube 22 with a fail-safe mode that reduces therisk of reconfiguration of the overtube in the event of tensioningmechanism failure.

[0124]FIG. 12B depicts pulley manifold 110, in which the yoke isreplaced with third groove 120. Third groove 120 is milled or moldedinto lateral surface 114, and accepts an additional tension wire 121that may be coupled to actuator 27 (see FIG. 2). When a proximallydirected force F is applied to tension wire 121, the force imposestension to tension wires 90. Third groove 120 includes a curved trackthat terminates at third distal ends 122, which preferably arediametrically disposed opposite each other at proximal surface 123 ofpulley manifold 110.

[0125] With respect to FIGS. 12A and 12B, an alternative embodiment of apulley manifold is described. Rather than having grooves disposed on alateral surface of the pulley manifold, pulley manifold 130 incorporatesfirst and second grooves 131 a and 131 b that terminate at tension wirebores 132 disposed through body 133. Preferably, tension wire bores 132are equidistantly and circumferentially disposed on proximal surface136. Pulley manifold 130 also incorporates central bore 134 thataccommodates colonoscope 10, and yoke 135 that couples pulley manifold130 to actuator 27 (see FIG. 2).

[0126] In FIG. 12C, first and second grooves 131 a and 131 b are milledor molded in overlapping fashion. To reduce friction between tensionwires disposed within the overlapping portion of the grooves, firstgroove 131 a may have a depth greater than that of second groove 131 b,or vice versa. In FIG. 12D, the first and second grooves do not overlap,first groove 131 a having a smaller radius of curvature than that ofsecond groove 131 b.

[0127] Applicants also contemplate that either the first or secondgroove of the pulley manifolds of FIGS. 12A-12D may be eliminated sothat a proximal force F applied thereto would impose a symmetricalcompressive clamping force to overtube 22 through a single length oftension wire 90 that extends through diametrically disposed tension wirelumens. Accordingly, when tension wire 90 or 121 breaks, or yoke 115fails, the overtube relaxes back into its flexible state, therebyreducing the risk of undesired reconfiguration of the overtube.

[0128] Referring now to FIGS. 13A and 13B, handle 21 is describedemploying pulley manifold 110 of FIG. 12B. Tension wires 90 withinovertube 22, skin 45, liner (not shown for illustrative purposes) andlumen 25 extend from distal region 23 (see FIG. 2), through overtube 22,and to handle 140, which preferably measures less than or equal to 5inches, similar to the other handle embodiments described herein. Withinhandle 140, tension wires are slidably coupled to pulley manifold 110,which rides within cylindrical extension 141 and cylinder 142.Cylindrical extension 141 may be integrally manufactured with housing143, and is configured to be inserted into a patient's rectum.Concentric with cylindrical extension 141, cylinder 142 defines theproximal portion of lumen 25 disposed within handle 140.

[0129] Via additional tension wire 121, pulley manifold 110 is coupledto slide block 92, which is keyed to translate in track 93. As in handle91 of FIG. 11, plunger 95 is coupled pivotally to slide block 92 at aproximal end, and slidably disposed within plunger housing 96 at adistal end. Concentrically disposed about plunger 95, compression spring98 biases hand grip 97 from being actuated absent an externally appliedforce. As in FIG. 11, compression spring 98 maintains the level oftension within tension wires 90 if adjacent nestable elements shiftslightly when overtube 22 is in the rigid state, thereby reducing therisk of reconfiguration of the overtube back to the flexible state.

[0130] Hand grip 97 also includes pawl 99, which is configured to engagetooth 144 of ratchet bar 145 to prevent distally-directed motion ofslide-block 92. Tooth 144 is disposed on ratchet bar 145 at apredetermined proximal location that permits a single actuation of handgrip 97 to completely transition overtube 22 from its flexible state toits shape-fixed state. Ratchet bar 145 is mounted pivotally in housing143 with a spring (not shown) that, with the aid of compression spring98, biases pawl 99 against tooth 144. To release tension from tensionwires 90, pawl 99 may be released from engagement with tooth 144 byrotating ratchet bar 145 in the proximal direction. This sufficientlyrelaxes tension wires 90 so that the tension wires retain little to notension, thereby permitting overtube 22 to assume its most flexiblestate.

[0131] Handle 140 also has shield 146 coupled to a distal end thereof.Shield 146 prevents handle 140 proximal thereto from inadvertently beinginserted into the patient's rectum. Handle 140 also incorporatesindicator 147 (FIG. 13B) that provides a clinician with informationabout the rigidity of overtube 22. Indicator 147 comprises slot 148disposed through a wall of housing 143, pointer 149 disposed throughslot 148, and scale 150 disposed on an external surface of housing 143adjacent to slot 148. Pointer 149 is coupled to translation of proximalmanifold 110 so that it translates with the manifold. Scale 150incorporates color gradations, or indicia (not shown) to indicate therigidity of overtube 22. Of course, it will be obvious to one ofordinary skill in the art that pointer 149 may be coupled to anystructure within handle 140 that moves when actuator 27 is actuated,e.g., slide block 92 or pawl 99. Alternatively, handle 140 may include aforce sensor coupled between the distal end of track 93 and slide block92.

[0132] It also will be evident to one of ordinary skill in the art thatany of the handle embodiments described herein also may incorporatecylindrical extension 141 for insertion into a patient's rectum, onetooth 144 on a ratchet bar to transition the overtube from a flexiblestate to a rigid state with a single actuation of actuator 27, shield146 to prevent insertion of the handle into the patient's rectum,indicator 147 to provide a clinician with information about the rigidityof the overtube, and combinations thereof.

[0133] Referring now to FIGS. 14A-14C, yet another alternativeembodiment of a tensioning mechanism suitable for use with the apparatusof the present invention is described. Handle 160 is adapted toreconfigure the overtube between its flexible and rigid states withsuccessive actuations of actuator 27. Handle 160 has housing 161containing plurality of fixed pillars 162 that are circumferentially andazimuthally disposed around inner cylindrical chamber 163 of housing161. Each fixed pillar 162 has beveled concavity 164 disposed on aproximal end adjacent beveled arm 165. Channel 166 is disposed betweenadjacent pillars 162.

[0134] Handle 160 also incorporates compression spring 167 proximallydisposed to bias rotatably mounted manifold 168 against plurality ofpillars 162. Manifold 168 incorporates plurality of distally projectingposts 169 having beveled distal ends 170 with inclination angles thatmatch those of beveled concavities 164 and beveled arms 165.Accordingly, when beveled distal ends 170 are forcefully engaged withbeveled concavities 164, a component of the force imparted by posts 169causes manifold 168 to rotate, absent the presence of beveled arm 165.Likewise, when the beveled distal ends are engaged with beveled arms165, a component of the force imparted by posts 169 rotates the manifoldso that pillars 162 are disposed at the proximal ends of channels 166.

[0135] Also attached to manifold 168 is tension spring 171, that in turnpreferably is coupled to one of the pulley systems of FIGS. 10A-10C or12A-12D. Tension spring 171 maintains tension wires 90 in constanttension if nestable elements disposed within the overtube slightly shiftwhen the overtube is rigidized. Accordingly, this reduces the risk ofreconfiguration of the overtube into the flexible state that otherwisewould occur absent tension spring 171.

[0136] Handle 160 further comprises translatable cylindrical collar 172having proximally projecting teeth 173. Each tooth has an inclinationangle that substantially is equivalent to that of beveled distal ends170 of manifold 168. Accordingly, when teeth 173 are engaged forcefullywith beveled distal ends 170, a component of the force imparted by theteeth rotates the manifold. Also coupled to collar 172 is actuator 27,illustratively translatable hand grip 174, that may be squeezed againststationary hand grip 175 to retract collar 172 in the proximal directionto contact beveled distal ends 170 of manifold 168.

[0137]FIG. 14B depicts the configuration of handle 160 when an overtubecoupled thereto is in the rigidized state. Beveled distal ends 170 ofmanifold 168 are engaged within concavities 164 of pillars 162. When itis desired to reconfigure the overtube into its flexible state,translatable hand grip 174 is squeezed against stationary hand grip 175.This action translates collar 172 in the proximal direction. When teeth173 engage beveled distal ends 170, continual proximal advancement oftranslatable hand grip 174 causes collar to push manifold 168 in theproximal direction against compression spring 167. When beveled distalends 170 clear beveled arm 165, the forces imparted by teeth 173 to thebeveled distal ends rotate manifold 168 so that beveled distal ends 170are engaged to beveled arms 165, as shown in FIG. 14B.

[0138] Retraction of collar 172 disengages teeth 173 from manifold 168.The forces imparted by beveled arm 165 to the beveled distal ends rotatemanifold 168 until the beveled distal ends clear pillar 162. Thereafter,the bias of compression spring 167 advances plurality of posts 169 intochannels 166. FIG. 14C depicts this configuration, in which the overtubeis in its flexible state.

[0139] To reconfigure the overtube back into its rigid state,translatable hand grip 174 again is squeezed against stationary handgrip 175. This proximally advances collar 172 until teeth 173 contactbeveled distal ends 170 of posts 169. Continual proximal actuation oftranslatable hand grip 174 causes collar 172 to push posts 169 out ofchannels 166. When beveled distal ends 170 clear pillars 162, the forcesimparted by teeth 173 to beveled distal ends 170 rotate manifold 168.Distal retraction of collar 172 disengages teeth 173 from manifold 168,and the bias of compression spring 167 advances manifold 168 untilbeveled distal ends 170 completely engage concavities 164.

[0140] Referring now to FIG. 15, still another alternative embodiment ofhandle 21 suitable for use with the apparatus of the present inventionis described. Handle 180 comprises housing 181 containing lumen 25 ofthe overtube. Handle 180 further includes piston 182 translatablydisposed within piston housing 183, which is coupled in pneumaticcommunication via port 184 and tube 185 with a pressure source (notshown). Attached to piston shaft 186 is pulley 187 around which proximaltension wire 188 is disposed. Proximal tension wire 188 is affixed tohousing 181 at its proximal end 189 and to tension spring 190 at itsdistal end. Preferably, tension spring 190 distally is coupled to one ofthe pulley systems of FIGS. 10A-10C or 12A-12D. Similar to tensionspring 171 of FIGS. 14A-14C and compression springs 98 of FIGS. 11 and13, tension spring 190 maintains the tension wires in constant tensionwhen the overtube is in the shape-locked state. This reduces the risk ofreconfiguration of the overtube to its flexible state if nestableelements disposed therein slightly shift relative to adjacent nestableelements.

[0141] To stiffen the overtube, the pressure source may be actuated toinfuse piston housing 183 with pressurized air that proximally advancespiston 182. This in turn advances pulley 187 in the proximal direction,so that tension is applied to proximal tension wire 188. That tension istransmitted through tension spring 190 to tension wires disposed withinthe overtube, thereby imposing a compressive clamping load to adjacentnestable elements disposed within the overtube. To transition theshape-locked overtube into the flexible state, the pressure source maybe actuated to remove air from piston housing 183. This retracts piston182 and pulley 183 in the distal direction, thereby releasing thecompressive clamping load applied to the overtube.

[0142] Pursuant to another aspect of the present invention, tensionspring 190 may be replaced with a damper per se known in the art. Inaddition to the advantages provided by the tension spring, the damperallows tension within proximal tension wire 188, and thus tension wiresdisposed within the overtube, to be slowly released. Applicantscontemplate that a damper may replace any of the compression and tensionsprings described herein.

[0143] Referring now to FIG. 16, apparatus 20 may be provided with atensioning mechanism that is selectively operable to transition overtube22 between the flexible and rigid states substantially without proximalmovement of distal region 23 (see FIG. 2). In FIG. 16, tension wire 196and lumen 25 extend from distal region 23, through overtube 22, and tohandle 195. Within handle 195, tension wire 196 is slidably coupled topulley manifold 197 that is rigidly or rotatably affixed to distal end198 of the handle. Pulley manifold 197 preferably includes orthogonallydisposed first and second channels 199 a and 199 b. While FIG. 16depicts only one tension wire, it should be understood that a secondtension wire preferably is disposed through second channel 199 b andnestable elements 30.

[0144] Similar to the tensioning mechanisms of FIGS. 12A-12D and 13, thepresent tensioning mechanism also provides overtube 22 with a fail-safemode. If the tension wires disposed through channels 199 comprise twoindependent wires, the load within overtube 22 remains symmetricallydistributed when one of the wires breaks. Thus, the risk ofreconfiguration of overtube 22 is reduced. If these tension wirescomprise a single length of wire, overtube 22 will relax into theflexible state if the single length of wire breaks.

[0145] Between pulley 197 and nestable elements 30, tension wire 196also extends through collar 200, which has distal surface 201 that iscontoured to mate with proximal surface 32 of the proximal-most nestableelement 30. Collar 200 is disposed to translate within housing 202 sothat distal surface 201 engages proximal surface 32 of nestable element30 when collar 220 is advanced in the distal direction.

[0146] Collar 200 pivotally is connected to plunger 95, which isslidably disposed within plunger housing 96. Plunger housing 96 in turnis mounted pivotally to actuator 27, illustratively hand grip 97. Tobias hand grip 97 against actuation absent an externally applied force,and to maintain constant tension within tension wire 196 when overtube22 is rigidized, compression spring 98 is provided concentricallydisposed about plunger 95.

[0147] Hand grip 97 also includes pawl 99, which is disposed to engageteeth 100 on ratchet bar 101 to prevent proximally-directed motion ofcollar 200. Ratchet bar 101 pivotally is mounted in housing 202 with aspring (not shown) that, with the aid of compression spring 98, biasespawl 99 against teeth 100 of ratchet bar 101. Handle 195 also mayincorporate annular extension 203 that is disposed surrounding collar200 and that may be inserted into a patient's rectum.

[0148] Similar in operation to handle 91 of FIG. 11, when hand grip 97is squeezed, pawl 99 engages the next distal-most tooth 100. This actionalso transmits force through compression spring 98, which pushes collar200 into engagement with the proximal-most nestable element. Continualactuation of hand grip 97 causes collar 200 to exert an increasingcompressive clamping load to nestable elements 30, which causes overtube22 to stiffen into its shape-locked state.

[0149] Advantageously, this configuration permits overtube 22 toreconfigure between the flexible and rigid states without substantialproximal movement of the distal end of the overtube. In previousembodiments, nestable elements 30 are advanced in the proximal directionwhen overtube 22 is rigidized, and due to compression of adjacentnestable elements, overtube 22 shortens in length. In contrast, when thepresent embodiment advances the nestable elements in the distaldirection, overtube 22 maintains its length despite compression ofadjacent nestable elements since the length of the overtubesubstantially is limited by the length of tension wire 196. Thisprovides greater accuracy when using the apparatus of the presentinvention, and is particularly useful in delicate procedures.

[0150] It will be apparent to one of ordinary skill in the art that,similar to the tensioning mechanism described in reference to FIG. 13,ratchet bar 101 may be provided with only one tooth. Alternatively, withminor modifications that will be evident to one of ordinary skill in theart, the tensioning system of FIGS. 14A-14C may be coupled to collar 200to transition overtube 22 between the flexible and rigid states withsuccessive actuations of actuator 27, or the piston mechanism describedin reference to FIG. 15 may be coupled to collar 200 to drivetranslation thereof. More specifically, rather than being pivotallycoupled to plunger 95, collar 200 instead may be fixedly coupled to apiston disposed to provide motion along the longitudinal axis of collar200. Furthermore, second channel 199 b may be eliminated from pulleymanifold 197 so that a single tension wire may translatably extendthrough first channel 199 a and diametrically disposed tension wirebores disposed within collar 200 and nestable elements 30. When thesingle tension wire breaks, the overtube relaxes into the flexible stateimmediately, thereby providing a fail-safe mode that reduces the risk ofundesired reconfiguration of the overtube.

[0151] With respect to FIGS. 17A and 17B, an alternative structure isdescribed to facilitate movement of a colonoscope within lumen 25 ofovertube 22. In particular, instead of using inner lining 43 as depictedin FIG. 4, some or all of nestable elements 30 may include rollerbearings 205 that are received in insets 206 formed in nestable elements30. Bearings 205 may be disposed on ring 207 to facilitate assembly ofthe device.

[0152]FIGS. 18A and 18B depict a further alternative embodiment, inwhich lubricious flexible rails 208 are disposed within bore 33 ofnestable elements 30. Rails 208 span the length of lumen 25, and reducecontact between the colonoscope and the interior of the overtube,thereby facilitating movement of the colonoscope through overtube 22.

[0153] In FIGS. 19 and 20, still further alternative structures aredescribed to facilitate movement of a colonoscope within lumen 25 ofovertube 22. More specifically, rather than using liner 43 as shown inFIG. 4, some or all of nestable elements 30 may incorporatehydrophilically-coated polymeric layer 209, which may be disposedsurrounding distal portion 210 of bore 33.

[0154] Alternatively, as described in FIGS. 20A and 20B, overtube 22 maycomprise multiplicity of frustoconical elements 215 that, when nested,provide a smooth inner lumen to accommodate colonoscope 10 without theneed for a separate liner. Each frustoconical element 215 includescentral bore 216, and at least two or more tension wire bores 217.Central bore 216 is defined by cylindrical distal inner surface 218 thathas a substantially constant diameter, and proximal inner surface 219that is continuous with distal inner surface 218.

[0155] Proximal inner surface 219 is slightly curved in a radiallyoutward direction so that, when tension wires 36 are relaxed, proximalinner surface 219 can rotate relative to external surface 220 of anadjacent element. External surface 220 of each frustoconical element maybe straight or contoured to conform to the shape of proximal innersurface 219, and tapers each element so that distal end 221 is smallerin outer diameter than proximal end 222. When frustoconical elements 215are nested together, distal inner surface 218 of each frustoconicalelement is disposed adjacent to the distal inner surface of an adjoiningfrustoconical element.

[0156] Advantageously, the present configuration provides lumen 25 witha substantially continuous profile. This permits smooth advancement ofcolonoscope 10 therethrough, and thereby eliminates the need to disposea separate liner within lumen 25. To provide a lubricious passageway tofurther facilitate advancement of the colonoscope, each frustoconicalelement optionally may incorporate an integral hydrophilic polymericlining as described with respect to the preceding embodiment of FIG. 19,or a thin, flexible lining having a hydrophilic coating may be disposedthrough lumen 25.

[0157] In FIGS. 21A-21C, yet another alternative structure is described,in which distal surface 31 of each nestable element is macroscopicallytextured to increase the friction between adjacent nestable elements 30when a compressive clamping load is applied to overtube 22.Illustratively, each element 30 may incorporate multiplicity of divots225 disposed on distal surface 31, and teeth 226 that are disposed onproximal surface 32 adjacent proximal edge 227. Teeth 226 are contouredto mate with the multiplicity of divots disposed on an adjacent element.Accordingly, when overtube 22 is tensioned, retraction of tension wires36 (see FIG. 3) applies a clamping load to elements 30 that causes teeth226 of each element to forcefully engage divots 225 of an adjacentelement. This reduces the risk of relative angular movement betweenadjacent nestable elements 30 when overtube 22 is shape-locked, which inturn reduces the risk of undesired reconfiguration of the overtube.

[0158] To prevent divots 225 and teeth 226 from engaging, and thusprovide smooth angular movement between adjacent elements 30, whenovertube 22 is in the flexible state, one or more leaf springs 228 maybe molded integrally with proximal surface 32. Accordingly, absentcompressive clamping load applied by tension wires 36 to stiffenovertube 22, leaf spring 228 of each element 30 coacts with distalsurface 31 of an adjacent element to prevent coaction of proximal anddistal surface 32 and 31, which prevents engagement of teeth 226 withdivots 225.

[0159] Alternatively, rather than having a leaf spring, nestableelements 30 may be provided with one or more cantilever springs 229 thatare cut from wall 34 and plastically bent into bore 33 of nestableelement 30. Similar to leaf springs 228, cantilever springs 229 preventcoaction between distal and proximal surfaces 31 and 32 so that teeth226 do not engage divots 225 absent a compressive clamping load.Cantilever springs 229 may be aligned with a longitudinal axis ofnestable element 30, as shown in FIG. 21B, and/or aligned with acircumference of nestable element 30, as shown in FIG. 21C. Applicantsalso contemplate that teeth 226 may be disposed on distal surface 31 anddivots 225 may be disposed on proximal surface 32. One of ordinary skillin the art will recognize additional macroscopic textures that willincrease friction between distal and proximal surfaces of adjacentelements 30.

[0160] On the other hand, instead of providing leaf or cantileversprings integral with nestable elements 30, thin, flexible disc 232(FIG. 21D) may be disposed between adjacent nestable elements 30 toprevent divots 225 (see FIGS. 21A-21C) and teeth 226 of the adjacentelements from engaging, absent a compressive clamping load. Each disc232 incorporates central bore 233 that accommodates a colonoscope, andis made from an elastomeric material. For purposes of illustration,nestable elements 30 and discs 232 are shown spaced-apart, but it shouldbe understood that the elements and discs are disposed so that distalsurface 31 of one element 30 and proximal surface 32 of an adjacentelement coacts with disc 232, which is disposed therebetween. It alsoshould be understood that each nestable element 30 also comprisestension wire bores, which are not shown in FIGS. 21A-21D forillustrative purposes.

[0161] Pursuant to one aspect of the present invention, nestableelements 30 also may incorporate band 231 that is disposed distallyadjacent to proximal edge 227. Band 231 increases the thickness of theproximal portion of wall 34 to distribute the applied compressiveclamping load over a larger cross-sectional area, and thereby reduceradially outward deflection of wall 34. This in turn reduceslongitudinal contraction of overtube 22. Band 231 preferably is madefrom a metal to provide greater structural integrity to wall 34, butalso may be integral therewith.

[0162] In accordance with another aspect of the present invention, thediameter of lumen 25 preferably is configured to facilitate simultaneouspassage of more than one diagnostic or therapeutic instrumenttherethrough. As shown in FIG. 22, lumen 25 may be dimensioned to permitauxiliary devices AD, such as for aspiration, biopsy, or additionallighting, to be advanced alongside colonoscope 10. For example, if lumen25 has a diameter of 13 mm and colonoscope 10 has an outer diameter of10 mm, auxiliary device AD, such as a catheter, having a diameter ofbetween 3F to 9F may be advanced through the remaining space withinlumen 25. Advantageously, this permits auxiliary devices AD to besuccessively placed within the patient's colon to perform additionaldiagnostic or therapeutic procedures without the need to removecolonoscope 10 and overtube 22 therefrom.

[0163] Referring to FIG. 23, an alternative embodiment of a distalregion suitable for use in the overtube of the present invention isdescribed. Distal region 235 is similar in construction to distal region23 of the embodiment of FIG. 4, but has flexible coil 236 embedded inonly the proximal portion of elastomeric layer 237. Atraumatic tip 238at the distal end of distal region 235 may further enhance thesteerability of overtube 22 when the steerable tip of the colonoscope isdisposed therein.

[0164] FIGS. 24-28 illustrate additional configurations of atraumatictips suitable for causing “tenting” of the wall of the hollow bodyorgan. As used herein, tenting refers to the tendency of the atraumatictip to be deflected radially outward in the vicinity of the tip of theovertube. This reduces the risk that the wall of the organ will becomepinched or caught between the colonoscope and the entry to overtube 22when the colonoscope is retracted within the overtube.

[0165]FIG. 24A shows atraumatic tip 24 in the form of an inflatabledonut-shaped balloon 240 affixed to distal region 23 of overtube 22.Inflation lumen 241 extends from the handle through overtube 22 toprovide fluid communication between balloon 240 and an inflation source,such as a syringe (not shown). As illustrated in FIG. 24B, when balloon240 is inflated, the wall of the colon radially deflects around balloon240. Thus, when colonoscope 10 is retracted into lumen 25, it is lesslikely that the wall of the colon will be pinched or potentiallydissected between overtube 22 and colonoscope 10. Furthermore, wheninflated, balloon 240 closes annular gap 242 disposed between the wallof overtube 22 and colonoscope 10 to prevent bodily fluids and othermatter from entering lumen 25. Advantageously, balloon 240 provides acustom fit around colonoscope 10.

[0166]FIG. 25 depicts a further alternative embodiment of atraumatic tip24, comprising soft membrane 245 covering shape memory alloy petals 246.Petals 246 preferably comprise loops of shape memory alloy wire, e.g.,nickel titanium alloy, and extend radially outward in the proximaldirection near the distal opening into lumen 25, so that the proximalend of membrane-covered petals causes the “tenting” effect describedhereinabove. The shape memory alloy may be activated to adopt apreformed shape when exposed to body temperature, and returned to acontracted state by flushing overtube 22 with cold water or air.Alternatively, petals 246 may be mechanically extended or retracted, orself-expanding.

[0167]FIG. 26 depicts a further alternative embodiment of atraumatic tip24. In the embodiment of FIG. 26, petals 250 covered by soft elastomericmembrane 251 extend distally from distal region 23 to form funnel-shapedelement 252. Atraumatic tip 24 provides a similar tenting effect to thatdescribed for the preceding embodiments.

[0168] FIGS. 27-28 provide further alternative configurations foratraumatic tip 86 of the embodiment of FIG. 9. Tip 255 preferablycomprises a foam or soft elastomer, and may be affixed to distal region23 of overtube 22 using a suitable biocompatible adhesive. FIG. 28depicts an alternative shape for a foam or soft elastomer bumper 260,which includes a proximally-extending flange 261. Of course, one ofordinary skill in the art will recognize that other configurations maybe used in accordance with the principles of the present invention toform atraumatic tips that cause localized tenting of the colon wall, andthese atraumatic tips may be used with the passively-steerable distalregions of the embodiments of FIGS. 4 and 23.

[0169] Referring now to FIGS. 29 and 30, alternative embodiments of theovertube are described. Unlike overtube 22 of previously describedembodiments, in which a mechanical mechanism is actuated to impart aclamping load to a multiplicity of nestable elements, the embodiments ofFIGS. 29 and 30 use alternative tensioning mechanisms. In particular,the following embodiments comprise a multiplicity of links to which acompressive clamping load may be applied by contraction of shape memorymaterials.

[0170] In FIG. 29, a first alternative embodiment of the overtube of thepresent invention is described. Overtube 270 includes multiplicity ofnestable elements 30 identical to those described hereinabove. Forpurposes of illustration, nestable elements 30 are shown spaced-apart,but it should be understood that elements 30 are disposed so that distalsurface 31 of each element 30 coacts with proximal surface 32 of anadjacent element. Each of nestable elements 30 has central bore 33 toaccommodate colonoscope 10, and preferably two or more tension wirebores 35. When assembled as shown in FIG. 29, nestable elements 30 arefastened with distal and proximal surfaces 31 and 32 disposed in acoacting fashion by a plurality of tension wires 271 that extend throughtension wire bores 35.

[0171] In contrast to overtube 22 of the previous embodiments, tensionwires 271 of the present overtube are made from a shape memory material,e.g., nickel titanium alloy or an electroactive polymer known in theart. Tension wires 271 are fixedly connected to the distal end ofovertube 270 at the distal ends and fixedly connected to handle 21 atthe proximal ends. When an electric current is passed through tensionwires 271, the wires contract in length, imposing a compressive clampingload that clamps distal and proximal surfaces 31 and 32 of nestableelements 30 together at the current relative orientation, thereby fixingthe shape of overtube 270. When application of electrical energy ceases,tension wires 271 re-elongates in length to provide for relative angularmovement between nestable elements 30. This in turn renders overtube 270sufficiently flexible to negotiate a tortuous path through the colon.

[0172] To provide overtube 270 with a fail-safe mode that reduces therisk of undesired reconfiguration of the overtube in the event oftensioning mechanism failure, diametrically disposed tension wires 271may be coupled in a serial circuit. Accordingly, when one wire fails,the wire disposed diametrically opposite also re-elongates to maintain asymmetrical clamping load within overtube 270. Alternatively, alltension wires 271 may be electrically coupled in a serial electricalcircuit. Accordingly, when one of the tension wires fails, overtube 270returns to the flexible state.

[0173] It should be understood that a tension spring (not shown) ordamper (not shown) that are similar to those described hereinabove maybe coupled between the proximal ends of tension wires 271 and handle 21(see FIG. 2). Inter alia, this maintains the tension wires in constanttension when the overtube is in the shape-locked state, thereby reducingthe risk of reconfiguration of the overtube to its flexible state ifnestable elements disposed therein slightly shift relative to adjacentnestable elements.

[0174] Alternatively, as described in FIG. 30, overtube 280 may includemultiplicity of nestable elements 281 that are similar to those of thepreceding embodiments. For purposes of illustration, nestable elements281 are shown spaced-apart, but it should be understood that elements281 are disposed so that distal surface 282 of each element 280 coactswith proximal surface 283 of an adjacent element. Each of nestableelements 280 has central bore 284 to accommodate colonoscope 10.

[0175] When assembled as shown in FIG. 30, nestable elements 280 arefastened with distal and proximal surfaces 282 and 283 disposed incoacting fashion by plurality of thin tension ribbons 285 that arefixedly connected to nestable bridge elements 286. Tension ribbons 285are made from a shape memory material, e.g., nickel titanium alloy or anelectroactive polymer, and may be transitioned from an equilibriumlength to a contracted length when electrical current is passedtherethrough.

[0176] Nestable bridge elements 286 are disposed within overtube 280between a predetermined number of nestable elements 281. Similar tonestable elements 281, bridge elements 286 also comprise central bore287 that accommodates colonoscope 10, distal surface 288 that coactswith proximal surface 283 of a distally adjacent nestable element, andproximal surface 289 that coacts with distal surface 282 of a proximallyadjacent nestable element 281. Each bridge element also incorporatesplurality of conductive elements 290 that are disposed azimuthallyaround central bore 287, and that preferably couple tension ribbons 285occupying the same angular circumferential position within overtube 280in a serial electrical circuit.

[0177] When an electrical current is passed through tension ribbons 285,the ribbons contract in length, imposing a compressive load that clampsdistal and proximal surfaces of adjacent nestable elements together atthe current relative orientation, thereby fixing the shape of overtube280. When the energy source ceases providing electricity, tensionribbons 285 re-elongates to the equilibrium length to provide forrelative angular movement between the nestable elements. This in turnrenders overtube 280 sufficiently flexible to negotiate a tortuous paththrough the colon.

[0178] Pursuant to another aspect of the present invention, tensionribbons 285 that are disposed at diametrically opposite circumferentialpositions may be electrically coupled in a serial circuit.Advantageously, this configuration provides overtube 280 with afail-safe mode that reduces the risk of undesired reconfiguration of theovertube in the event that one of the electrical circuits establishedthrough the tension ribbons is de-energized.

[0179] For example, overtube 280 of FIG. 30 may be provided with foursets of tension ribbons equidistantly disposed at 90° intervals. In theevent that tension ribbons T_(a) de-energize, absent electricalcommunication between tension ribbons T_(a) and tension ribbons T_(c)disposed diametrically opposite thereto, overtube 280 will spontaneouslyreconfigure into a new rigidized shape since the tension within theovertube no longer will be symmetrically balanced. The new shape ofovertube 280 may not replicate the tortuous path of the colon, and thusmay cause substantial harm to the patient.

[0180] Advantageously, the present invention may reduce the risk ofundesired reconfiguration preferably by electrically couplingdiametrically disposed tension ribbons in a serial circuit. When tensionribbons T_(a) are de-energized, tension ribbons T_(c) also de-energizeto provide overtube 280 with symmetrical tension, as provided by tensionwires T_(b) and the tension wires disposed diametrically oppositethereto (not shown). In this manner, the overtube retains its desiredrigidized shape in the event that the tensioning mechanism malfunctions.To immediately return overtube 280 to its flexible state in the eventthat any of the tension ribbons are de-energized, all tension ribbons285 may be electrically coupled in a serial circuit.

[0181] In an alternative embodiment, tension ribbons 285 may beelectrically coupled to rigidize select regions of the overtube withoutrigidizing the remainder of the overtube. Illustratively, this may beaccomplished by coupling longitudinally adjacent tension ribbons in aparallel circuit, and circumferentially adjacent tension ribbons in aserial circuit.

[0182] Of course, it will be evident to one of ordinary skill in the artthat, while FIG. 30 depicts tension ribbons 285 to be disposed withincentral bores 284 and 287, the tension ribbons also may be disposedadjacent external lateral surfaces 292 of nestable elements 281 and 286.Alternatively, the tension ribbons may extend through tension ribbonbores (not shown) that may extend through the distal and proximalsurfaces of nestable elements 281, and be affixed to nestable bridgeelements 286.

[0183] With respect to FIGS. 31-37, alternative embodiments of overtube22 are described. Unlike overtube 22 of the above-described embodiments,which comprised a multiplicity of nestable elements that are clampedwith a plurality of tension wires or ribbons, the embodiments of FIGS.31-37 use alternative clamping mechanisms. In particular, the followingembodiments comprise a plurality of links that may be stiffened by theuse of compressive sleeves that compress individual links disposed alongthe length of the overtube.

[0184] Referring now to FIGS. 31A-31C, a fourth alternative embodimentof the overtube of the present invention is described. Overtube 300comprises a multiplicity of alternating spool links 301 and clamp links302. Each spool link 301 and clamp link 302 has a bore disposedtherethrough to accommodate a standard colonoscope. Spool link 301comprises rounded edges 303 disposed on its distal and proximal endsthat are contoured to permit limited rotatable engagement with one oftwo contoured grooves 304 disposed within the bore of clamp link 302.Accordingly, clamp link 302 comprises a greater outer diameter thanspool link 301. Each clamp link 302 also has through-wall split 305longitudinally disposed to permit a reduction in the diameter of clamplink 302 when the clamp link is compressed, as discussed hereinafter.

[0185] Still referring to FIGS. 31A-31C, a first embodiment of acompressive sleeve comprising inflatable sleeve 310 having firstcompressive portions 311 and second compressive portions 312. Sleeve 310is configured so that the inner diameters of second compressive portions312 are smaller than those of first compressive portions 311 when sleeve310 is inflated. Second compressive portions 312 may be disposed toengage clamp links 302. Thus, when inflatable sleeve 310 is inflated byan inflation source (not shown) coupled to the handle, secondcompressive portions 312 compress against clamp links 202 to shape-fixovertube 300. In FIGS. 31B and 31C, cross sectional views of firstcompressive portions 311 and second compressive portions 312,respectively, are shown when sleeve 310 is in its inflated state.

[0186]FIG. 32 illustrates an alternative embodiment of a compressivesleeve that also comprises an inflatable bladder. Unlike inflatablebladder 310 of FIGS. 31A-31C, spiral bladder 320 has a constant innerdiameter. Spiral bladder 320 preferably is helically disposed around theovertube. Accordingly, when bladder 320 is inflated, clamp links 302 arecompressed onto spool links 301 to stiffen the overtube.

[0187]FIG. 33 depicts a further embodiment of a compressive sleeve 330,comprising discontinuous hoops 331 made of shape memory alloy (e.g.nickel titanium alloy). Each hoop 331 includes gap 332, which is spannedby spring 333. Each hoop 331 is electrically connected to neighboringhoops 331 via insulated wires 334, so that a serial electrical circuitis established. When hoops 331 are energized, they undergo a phasetransition that causes the hoops to contract into a preformed shape thatis diametrically smaller than the non-energized shape. Since hoops 331may be disposed about clamp links 302, contraction of hoops 331 may beused to apply a clamping load that compresses links 302 onto spool links301 to stiffen the overtube.

[0188] Springs 333 contribute to structural integrity when hoops 331 arein their non-energized state. To energize and thereby contract hoops331, an electrical current may be run through wires 334. To return hoops331 to their non-contracted state and thereby return the overtube to itsflexible state, hoops 331 may be flushed with cold water or air. Ofcourse one of ordinary skill in the art will recognize that hoops 331also may be individually energized, thus requiring a parallel circuit.

[0189] With respect to FIGS. 34A-34B, a still further alternativeembodiment of an overtube suitable for use in the present invention isdescribed. This embodiment comprises helical links 340 that are formedfrom an integral strip 341 having regions of different durometer, e.g.,rigid material 342 and soft material 343. When strip 341 is helicallywound, helical links 340 are formed having rigid portions 344 and softportions 345. Rigid portions 344 provide structural integrity to theovertube, while soft portions 345 provide flexibility.

[0190] Helical links 340 are disposed within compressive sleeve 346,which includes first compressive portions 347 and second compressiveportions 348. Compressive sleeve 346 is identical in structure andoperation to that described in FIGS. 31A-31C, except that secondcompressive portions 348 are aligned with, and apply a clamping forceto, rigid portions 344 of helical links 340. It will of course beunderstood that an overtube in accordance with the principles of thepresent invention could alternatively be formed using helical links 340and either of the clamping systems described with respect to FIGS. 32and 33.

[0191] Referring now to FIG. 35, another alternative embodiment of anovertube is described, in which each Grecian link 350 includes rigidfirst and second rims 351 and 352 disposed at longitudinally opposingends of flexible body 353. First rim 351 comprises U-shaped arm 354 thatdefines channel 355 and opening 356. Second rim 352 includes retroflexedarm 357, which when engaged to first rim 351 of an adjacent, is disposedwithin channel 355 of U-shaped arm 354 through opening 356 so thatU-shaped arm 354 and retroflexed arm 357 are engaged and overlap alongthe longitudinal axis of the overtube.

[0192] Grecian links 350 are disposed within compressive sleeve 358,which includes first compressive portions 359 and second compressiveportions 360. Compressive sleeve 358 is identical in structure andoperation to that described in FIGS. 31A and 34A, except that secondcompressive portions 360 are aligned with, and apply a clamping forceto, overlapping U-shaped arm 354 and retroflexed arm 357 of the firstand second rims. It will of course be understood that an overtube inaccordance with the principles of the present invention couplealternatively be formed using Grecian links 350 and either of theclamping systems described with respect to FIGS. 32 and 33.

[0193] Referring now to FIG. 36, yet another alternative embodiment ofan overtube suitable for use in the present invention is described. Thisembodiment comprises joint links 370 that include ball 371 and socket372 disposed at longitudinally opposing ends of flexible body 373. Whenadjacent joint links 370 are engaged, ball 371 of one link is disposedwithin socket 372 of an adjacent link. When the overtube is flexed, ball371 coacts with socket 372 to provide articulation of the overtube.

[0194] Joint links 370 are disposed within compressive sleeve 374, whichincludes first compressive portions 375 and second compressive portions376. Compressive sleeve 374 is identical in structure and operation tothat described in FIGS. 31A, 34A and 35, except that second compressiveportions 376 are aligned with, and apply a clamping force to, socket 372within which ball 371 of an adjacent link is disposed. It will of coursebe understood that an overtube in accordance with the principles of thepresent invention couple alternatively be formed using joint links 370and either of the clamping systems described with respect to FIGS. 32and 33.

[0195] With respect to FIG. 37, a still further embodiment of anovertube suitable for use in the apparatus of the present invention isdescribed. Overtube 380 comprises a heat-softenable polymer layer 381,(e.g., Carbothane®, a proprietary urethane-based polymer available fromThermedics Polymer Products, Woburn, Mass.), having wire 382 embeddedwithin it. Wire 382 is coupled at the handle to an energy source, sothat by passing an electric current through wire 382, sufficientresistive heating occurs to soften the polymer layer 381, rendering itsufficiently flexible to negotiate tortuous or unsupported anatomy. Whenelectrical energy is not supplied to wire 382, no resistive heating ofthe wire or the polymer layer occurs, and the overtube instead cools andstiffens. Wire 382 serves the dual purpose of providing kink resistanceand electric heating.

[0196] Still referring to FIG. 37, yet another alternative embodiment ofan overtube suitable for use in the present invention comprises a softelastomeric polymer layer 381 having a shape memory alloy wire 382embedded within layer 381. In this embodiment, the shape memory alloy isselected to have a martensite transition temperature above bodytemperature. When wire 382 is heated to a temperature above bodytemperature, such as by passing an electric current through it, the wiretransitions into the austenitic phase, and becomes stiffer, therebyshape locking the overtube. When application of the electric currentceases, wire 382 cools back into the martensitic phase, and renders theovertube flexible.

[0197] Referring now to FIGS. 38A-38C, an additional alternativeembodiment of an overtube suitable for use with the present invention isdescribed. Overtube 390 comprises elongate body 391 having central lumen392 that accommodates colonoscope 10, and wire lumens 393 that aredefined by cylindrical wire lumen surfaces 394. Within each wire lumen393 is disposed wire 395 that extends the length of the elongate body.Elongate body 391 is made from an electroactive polymer known in the artthat permits wire lumens 393 to vary in diameter responsive toelectrical energization.

[0198] In particular, when an electrical current is passed throughelongate body 391, the diameter of each wire lumen 393 decreases so thatthe wire lumens clamp around respective wires 395. Preferably, bothwires 395 and wire lumen surfaces 394 are textured to enhance frictiontherebetween. This prevents further relative movement between elongatebody 391 and wires 395, and stiffens overtube 390. When application ofthe electrical current ceases, wire lumens 393 increase in diameter torelease wires 395 so that elongate body 391 may shift relative to wires395. This in turn renders overtube 390 sufficiently flexible tonegotiate a tortuous path through the colon.

[0199] With respect to FIG. 39, yet another alternative embodiment ofthe overtube is described. Overtube 400 incorporates multiplicity ofvariable diameter links 401 disposed in overlapping fashion surroundingmultiplicity of rigid links 402, that provide structural integrity tothe overtube. Each link comprises a central bore that defines lumen 25of the overtube, and accommodates a standard commercially availablecolonoscope. Variable diameter links 401 preferably are manufacturedfrom an electroactive polymer or a shape memory alloy that contract indiameter when energized. When variable diameter links 401 areelectrically activated, the variable diameter links tighten about rigidlinks 402 to transition overtube 400 into a shape-locked state. When thevariable diameter links are electrically deactivated, the variablediameter links sufficiently soften to return overtube 400 back to theflexible state.

[0200] In a preferred embodiment, variable diameter links 401 and rigidlinks 402 are formed from respective strips of material that arehelically wound in an overlapping fashion to form overtube 400.Alternatively, each link may be individually formed and disposed in anoverlapping fashion.

[0201] In FIGS. 40A-40B, still another alternative embodiment of anovertube suitable for use with the apparatus of the present invention isillustrated schematically. Overtube 405 comprises multiplicity ofnestable hourglass elements 406 that preferably are manufactured from anelectroactive polymer or a shape memory alloy, and each have bulbousdistal and proximal portions 407 and 408 connected by neck 409. Thediameter of neck 409 is smaller than the maximum diameter of distalportion 407, which in turn is less than the maximum diameter of proximalportion 408. The distal portion of external surface 410 of eachhourglass element 406 is contoured to coact with the proximal portion ofinternal surface 411 of a distally adjacent hourglass element.Accordingly, when a multiplicity of hourglass elements are nestedtogether to form overtube 405, adjacent elements 406 may move relativeto each other when the overtube is in the flexible state.

[0202] To reduce friction between adjacent elements during relativemovement therebetween, proximal portions 408 include plurality of slits412 disposed contiguous with proximal edge 413. Slits 412 alsofacilitate contraction of proximal portion 408 of each element arounddistal portion 407 of an adjacent element. Each hourglass element 406also has central bore 414 that accommodates colonoscope 10 (see FIG. 1).

[0203] When an electrical current is applied to multiplicity of nestablehourglass elements 406, proximal portion 408 of each element contractsin diameter around distal portion 407 of an adjacent element. Thecompressive clamping force thereapplied prevents relative movementbetween adjacent elements, thereby shape-locking the overtube. When thenestable elements are deenergized, proximal portions 408 sufficientlyrelax to permit relative movement between adjacent nestable elements406, and thus permit overtube 405 to negotiate tortuous curves. Forpurposes of illustration, it should be understood that the figures ofthe present application may not depict an electrolytic medium,electrodes, and insulated wires that are coupled to and facilitateionization, and thus contraction, of the electroactive polymersdescribed herein.

[0204] In accordance with another aspect of the present invention, theovertube of the present invention may be provided with disposable sheath420 that may extend the length of overtube 22 and be removed therefrom.Like the sheath described hereinabove with respect to FIG. 4, sheath 420of FIG. 41 also incorporates distally-disposed atraumatic tip 421 andflexible, kink-resistant coil 422 encapsulated in flexible layer 423. Atits proximal end, layer 423 joins or is integrally formed withlubricious liner 424 defining lumen 425, and flexible elastomeric skin427. Liner 424 may incorporate optional flexible, kink-resistant coil429, be made of a thin, flexible material, and/or have a hydrophiliccoating thereon, similar to that described in reference to FIG. 4.Between liner 424 and skin 427 is disposed annular chamber 428 withinwhich nestable elements 30 may be inserted. Sheath 420 is configured toslide onto and be removed from a column of nestable elements 30 so thatthe sheath may be discarded after a single use, while the nestableelements and handle may be sterilized and reused. Advantageously,substantial cost reductions may be realized.

[0205] Pursuant to another aspect of the present invention, apparatus 20further may be provided with a device to secure colonoscope 10 toapparatus 20 prior to insertion of apparatus 20 and colonoscope 10 intothe patient. FIG. 42 depicts strap 430 that may be secured distally tohandle 21 of apparatus 20 and proximally to proximal portion 13 ofcolonoscope 10. Strap 430 preferably has a length that preventscolonoscope 10 from decoupling from apparatus 20 after the colonoscopeis placed within the overtube. Illustratively, strap 430 may be made ofductile wire or Velcro. If strap 430 is made of ductile wire, the strapmay be secured to anchors 431 and 432 respectively disposed on handle 21and colonoscope 10. Anchor 432 may be integral with, or comprise anadhesive suitable for application to colonoscope 10.

[0206] It will be obvious to one of ordinary skill in the art that,while the above description has emphasized use of apparatus 20 in thelower gastro-intestinal tract, and in particular, in performingcolonoscopy, the apparatus of the present invention also may be used inthe upper gastro-intestinal tract, and in laparoscopic procedures as avariable rigidity trocar through which a steerable laparoscopicendoscope or tool may be advanced. Apparatus 20 also may be scaled downin size for use in endo-urological procedures. For example, aminiaturized overtube may be advanced, along with a steerablenephrescope, through a patient's ureter into a kidney for access to thekidney's lower pole.

[0207] While preferred illustrative embodiments of the invention aredescribed above, it will be apparent to one skilled in the art thatvarious changes and modifications may be made therein without departingfrom the invention. The appended claims are intended to cover all suchchanges and modifications that fall within the true spirit and scope ofthe invention.

1. Apparatus for advancing a first diagnostic or therapeutic instrumentinto a hollow body organ of unsupported anatomy, the apparatuscomprising: a handle; an overtube coupled to the handle, the overtubehaving proximal and distal ends, an exterior surface, an interiorsurface that defines a lumen extending between the proximal and distalends to permit passage of the first diagnostic or therapeuticinstrument, a flexible state that facilitates insertion of the overtubeinto a hollow body organ, and a rigid state wherein the overtube resistsbending forces exerted on the interior surface during insertion orwithdrawal of the first diagnostic or therapeutic instrument through thelumen; and a tensioning system selectively operable to transition theovertube between the first and second states, the tensioning systemhaving a fail-safe mode that reduces the risk of undesiredreconfiguration of the overtube in the event of tensioning systemfailure.
 2. The apparatus of claim 1, further comprising a disposablesheath having a first portion that extends through the lumen to providea barrier between the interior surface and the first diagnostic ortherapeutic instrument and a second portion that extends over theexterior surface.
 3. The apparatus of claim 2, wherein the disposablesheath comprises a hydrophilic material.
 4. The apparatus of claim 2,wherein the disposable sheath comprises a non-kinking coil.
 5. Theapparatus of claim 2, wherein the first portion comprises a thin,flexible material.
 6. The apparatus of claim 1, wherein the overtubecomprises a plurality of nestable links that each has a lateral wall. 7.The apparatus of claim 6, wherein the plurality of nestable links aremade from a material selected from the group consisting of polymers,metals and combinations thereof.
 8. The apparatus of claim 7, whereinthe polymer is filled with glass fiber, carbon fiber, or combinationsthereof.
 9. The apparatus of claim 8, wherein the polymer ispolyurethane.
 10. The apparatus of claim 6, wherein each one of theplurality of nestable links comprises a distal surface and a proximalsurface.
 11. The apparatus of claim 10, wherein the distal surface ismacroscopically textured, and the proximal surface comprises teethconfigured to engage the distal surface.
 12. The apparatus of claim 11,wherein each one of the plurality of nestable links further comprisesone or more springs that prevent coaction between the distal andproximal surfaces of adjacent ones of the plurality of nestable links,absent an externally applied force.
 13. The apparatus of claim 11,further comprising a plurality of elastomeric discs, wherein each one ofthe plurality of elastomeric discs is disposed between adjacent ones ofthe plurality of nestable links.
 14. The apparatus of claim 10, whereineach one of the plurality of nestable links further comprises a proximaledge and a band circumferentially disposed around the distal surfaceadjacent to the proximal edge.
 15. The apparatus of claim 10, wherein aradius of curvature of the proximal surface closely approximates aradius of curvature of the distal surface.
 16. The apparatus of claim10, wherein a coefficient of static friction between the distal andproximal surfaces are within a range of about 0.2 to 1.4, inclusive. 17.The apparatus of claim 6, further comprising: a plurality of tensionwire bores extending through the lateral wall of each one of theplurality of nestable links; and at least one tension wire translatablydisposed through one or more of the plurality of tension wire bores. 18.The apparatus of claim 17, wherein the at least one tension wire has afirst diameter and each one of the plurality of tension wire bores has asecond diameter, and the ratio of the first diameter to the seconddiameter is in a range of approximately ½ to ⅔.
 19. The apparatus ofclaim 6, wherein each one of the plurality of nestable links comprisesan integral lubricious liner.
 20. The apparatus of claim 6, wherein theovertube increases in axial length by less than or equal toapproximately 0.31 inch when one of the plurality of nestable links isnested within another one of the plurality of nestable links.
 21. Theapparatus of claim 6, wherein the tensioning system comprises aplurality of tension wires that thread the plurality of nested linkstogether.
 22. The apparatus of claim 21, wherein the tensioning systemis configured so that tension within each one of the plurality oftension wires is dependent on tension within the remaining plurality oftension wires.
 23. The apparatus of claim 21, wherein the tensioningsystem comprises a pulley manifold.
 24. The apparatus of claim 23,wherein the pulley manifold further comprises a plurality of grooveswithin which the plurality of wires are slidably disposed.
 25. Theapparatus of claim 24, wherein the plurality of grooves are disposed ona lateral surface of the pulley manifold.
 26. The apparatus of claim 24,wherein the plurality of grooves are disposed on a proximal surface ofthe pulley manifold.
 27. The apparatus of claim 23, wherein the pulleymanifold is affixed within the handle.
 28. The apparatus of claim 21,wherein the plurality of tension wires comprises at least one length ofwire.
 29. The apparatus of claim 21, wherein the plurality of tensionwires comprises a shape memory material.
 30. The apparatus of claim 21,wherein the plurality of tension wires comprises a superelasticmaterial.
 31. The apparatus of claim 1, wherein the tensioning systemfurther comprises a piston.
 32. The apparatus of claim 1, wherein thetensioning system comprises a spring.
 33. The apparatus of claim 1,wherein the tensioning system comprises a damper.
 34. The apparatus ofclaim 1, wherein the tensioning system is selectively operable totransition the overtube between the flexible and rigid states withoutsubstantial proximal movement of the distal end of the overtube.
 35. Theapparatus of claim 34, wherein the tensioning system is configured toapply a distally-directed clamping load to the overtube.
 36. Theapparatus of claim 6, wherein the tensioning system further comprises aplurality of nestable bridge links interposed between a predeterminednumber of the plurality of nestable links, and a plurality of ribbons,wherein each one of the plurality of ribbons is coupled to adjacent onesof the plurality of nestable bridge links.
 37. The apparatus of claim36, wherein the plurality of ribbons comprises a shape memory material.38. The apparatus of claim 1, wherein the tensioning system isconfigured to transition the overtube from the flexible state to therigid state with a single actuation of the actuator.
 39. The apparatusof claim 1, wherein the tensioning system is configured to transitionthe overtube between the flexible and rigid states with successiveactuations of the actuator.
 40. The apparatus of claim 1, wherein thehandle further comprises an extension suitable for insertion into thehollow body organ.
 41. The apparatus of claim 1, wherein the handle hasa length less than or equal to approximately 5 inches.
 42. The apparatusof claim 1, wherein the handle comprises an indicator that providesinformation about the rigidity of the overtube.
 43. The apparatus ofclaim 1, wherein a thickness of the overtube is less than or equal toapproximately 1 mm.
 44. The apparatus of claim 1, further comprising astrap configured to releasably couple the handle of the apparatus to aproximal end of the first diagnostic or therapeutic instrument.
 45. Theapparatus of claim 1, wherein the handle further comprises a shield thatprevents a proximal portion of the handle from being inadvertentlyinserted into the hollow body organ.